Patient Information and Documents

Thank you for your interest in becoming a patient at Families First, Goodwin Community Health or Lilac City Pediatrics. Let’s get started!

Getting Started as a New Patient

Please click the arrow next to the name of the health center where you would like to become a patient. Our staff would be happy to answer any questions or to provide you with a hard copy of any document. Contact information for staff at each health center is below. 

Please choose one of these ways to complete the paperwork to become a new patient:

  1. Click this link to register online (preferred)
  2. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Families First, 100 Campus Drive,  Portsmouth, NH, 03801. 
    Espanol | Indonesia 
  3. If you need information mailed to you, use the form on this page to request it.

What’s next?

Once we receive and process your paperwork – this takes 7-10 business days – we will contact you to schedule your first appointment. 

Bring to your first appointment:

  • A list of the medications you take, or the actual medications
  • Your insurance cards, co-payment or sliding-fee-scale payment

Please choose one of these ways to complete the paperwork to become a new patient:

  1. Click this link to register online (preferred)
  2. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Goodwin Community Health, 311 Route 108, Somersworth, NH 03878.
    Espanol | Indonesia
  3. If you need information mailed to you, use the form on this page to request it.

What’s next?

Once we receive and process your paperwork – this takes 7-10 business days – we will contact you to schedule your first appointment. 

Please choose one of these ways to complete the paperwork to become a new patient:

  1. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Lilac City Pediatrics, 180 Farmington Road, Rochester, NH 03867.
    Espanol | Indonesia
  2. If you need information mailed to you, use the form on this page to request it.

Request your child’s medical records from their previous or current pediatrician. Ask the provider to mail the records to: 
Lilac City Pediatrics, 180 Farmington Road, Rochester, NH 03867. 

Wait one week after your provider has sent the medical records and you have sent in your application, then call us at 603-335-4522 to schedule your child’s first appointment.

We look forward to meeting your family!

One of the forms asks you to acknowledge that you have access to these documents, which you may read by clicking these links:

Annual Paperwork for Established Patients

Please scroll down to find the paperwork that we ask all patients to complete annually. Our staff would be happy to answer any questions or to provide you with a hard copy of any document. Contact information for staff at each health center is below. 

Please do this to complete your annual patient paperwork:

  1. Click this link to complete online (preferred)
  2. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Families First, 100 Campus Drive,  Portsmouth, NH, 03801.  
    Espanol | Indonesia

Please do this to complete your annual patient paperwork:

  1. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Goodwin Community Health, 311 Route 108, Somersworth, NH 03878.
    Espanol | Indonesia
  •  

Please do this to complete your annual patient paperwork:

  1. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Lilac City Pediatrics, 180 Farmington Road, Rochester, NH 03867.
    Espanol | Indonesia

One of the forms asks you to acknowledge that you have access to these documents, which you may read by clicking these links:

Forms for Patients

Helpful Links and Info for Patients

  • Pay my bill
  • Sliding Fee Scale (updated April 2021)
  • How to reach us after hours: Call the regular number for your health center and listen for instructions.
  • More links coming soon!